Provider Demographics
NPI:1881905461
Name:BAKER, MARY LANGLEY (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LANGLEY
Last Name:BAKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 EAST SECOND STT
Mailing Address - Street 2:
Mailing Address - City:KENLY
Mailing Address - State:NC
Mailing Address - Zip Code:27542
Mailing Address - Country:US
Mailing Address - Phone:919-284-2333
Mailing Address - Fax:919-284-2717
Practice Address - Street 1:104 EAST SECOND STT
Practice Address - Street 2:
Practice Address - City:KENLY
Practice Address - State:NC
Practice Address - Zip Code:27542
Practice Address - Country:US
Practice Address - Phone:919-284-2333
Practice Address - Fax:919-284-2717
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC6801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0505172Medicaid